Provider Demographics
NPI:1336976695
Name:BEDNAR, TASHANA
Entity type:Individual
Prefix:
First Name:TASHANA
Middle Name:
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34868 MISSION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1320
Mailing Address - Country:US
Mailing Address - Phone:760-408-6497
Mailing Address - Fax:
Practice Address - Street 1:73255 EL PASEO STE 18
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4249
Practice Address - Country:US
Practice Address - Phone:760-385-3959
Practice Address - Fax:760-406-5621
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical